HIV Disclosure to Partners and Family among Women Enrolled in Prevention of Mother to Child Transmission of HIV Program: Implications for Infant Feeding in Poor Resourced Communities in South Africa

Abstract

The introduction of routine HIV counselling and testing (HCT) has increased the number of pregnant women being tested and receiving prevention of mother to child transmission of HIV (PMTCT) interventions in South Africa. While many women may enroll in PMTCT, there are barriers that hinder the success of PMTCT programmes. The success of the PMTCT is dependent on the optimal utilization of PMTCT interventions which require the support of the woman's partner, and other members of her family. We conducted focus groups interviews with 25 HIV-positive post-natal women enrolled in PMTCT, in the City of Tshwane, South Africa. The study explored HIV-positive status disclosure to partners and significant family members and assessed the effect of nondisclosure on exclusive infant feeding. Most women disclosed to partners while few disclosed to significant family members. Most women initiated mixed feeding practices as early as one month and reported that they were pressurized by the family to mix feed. Mixed feeding was common among women who had not disclosed their HIV-positive status to families, and women who had limited understanding of mother to child transmission of HIV. Women who disclosed to partners and family were supported to adhere to the feeding option of choice. Health providers have a critical role to play in developing interventions to support HIV pregnant women to disclose in order to avoid mixed feeding. Improving the quality of information provided to HIV-positive pregnant women during counselling will also reduce mixed feeding.

Barriers to male involvement in uptake of Prevention-of-Motherto-Child-Transmission (PMTCT) of HIV in Sub-Saharan Africa

“…Barriers to male involvement Madiba, et al (2013), discovered that disclosure of HIV sero-status to a partner is always the main gate to progress in PMTCT uptake and that is what pregnant women in Sub-Saharan Africa do not have confidence to do, due to the fear of negative reactions they will face from their husbands and relations. A study carried out by Bajunirwe et al (2005) in rural and urban Uganda found that women refused HIV testing in antenatal clinic due to fear of their husbands" reactions.…”

Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A Scoping Review of counselling, socioeconomic and cultural factors

“…Studies have shown that HCWs are likely to give adapted messages based on what they believe to be the best feeding choice for mothers (Tijou-Traore et al, 2009;Wachira et al, 2009;Madiba et al, 2013). For example, some studies have found that EFF was suggested for women of high socio-economic status while EBF was recommended for mothers of low socio-economic status (Koricho et al, 2010;Chinkonde et al, 2012).…”

“…In addition, the timing for infant feeding counselling should be considered carefully and not given for example at the time of a new HIV diagnosis (Doherty et al, 2006a;Leshabari et al, 2006). Furthermore, mothers may receive inconsistent information or advice on infant feeding practices from various HCWs in different departments within the same health facility (Doherty et al, 2006a;Chisenga et al, 2011;Chinkonde et al, 2012;Madiba et al, 2013).…”

Suporte social de gestantes com HIV: revisão narrativa

“…Quanto à categoria suporte social emocional, observaram-se como fontes a família, 12,14,15,24,25,[27][28][29] o companheiro, 10,22,26 os amigos 15,24,27 e a crença em Deus e a fé, 15,24,27 como estímulos para continuidade do tratamento. Fica explícito que as questões culturais e familiares influenciaram nas decisões em relação aos cuidados de saúde maternos e infantis.…”

“…Conforme os estudos, 12,14,25,28 as gestantes acreditavam que os familiares apresentavam opiniões e percepções negativas acerca das pessoas com HIV, o que poderia gerar estigma e discriminação.…”